Achieving basic rights in health-care facilities in low-income countries
Authors: Eilish Hannah, Bernadette O’Hare, Marisol Lopez, Stephen Hall
Journal: The Lancet Global Health (2022)

In The Lancet Global Health, Michael Chaitkin and colleagues1Chaitkin M McCormick S Alvarez-Sala Torreano J et al.Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study.Lancet Glob Health. 2022; 10: e840-e849Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar modelled the cost of providing public health-care facilities in the 46 UN designated least-developed countries, with basic services. These services include basic water, sanitation, hygiene, and waste management services, which are Sustainable Development Goals and fundamental human rights. The total cost is estimated to be between US$6·5 and $9·6 billion from 2021 to 2030 in constant 2020 prices, including capital investment and recurrent costs.1Chaitkin M McCormick S Alvarez-Sala Torreano J et al.Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study.Lancet Glob Health. 2022; 10: e840-e849Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar The question of how this will be financed is crucial. It has been shown that domestic public financing is much more effective than external financing, and domestic resource mobilisation is essential.2Atim C Arthur E Achala DM Novignon J An assessment of domestic financing for reproductive, maternal, neonatal and child health in sub-saharan africa: potential gains and fiscal space.Appl Health Econ Health Policy. 2020; 18: 789-799Crossref PubMed Scopus (3) Google Scholar Experts believe that increasing government revenue through corporation tax is the most feasible short-to-medium-term solution.3Durst MC Taxing multinational business in lower-income countries: economics, politics and social responsibility.https://opendocs.ids.ac.uk/opendocs/bitstream/handle/123456789/14336/Durst_Book_Final.pdf?sequence=1&isAllowed=yDate: 2019Date accessed: May 11, 2022Google Scholar We would like to highlight that the 46 UN designated least-developed countries combined currently lose $6·5 billion each year due to tax abuse and, over the same time period of Chaitkin and colleagues' study,1Chaitkin M McCormick S Alvarez-Sala Torreano J et al.Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling study.Lancet Glob Health. 2022; 10: e840-e849Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar are expected to lose at least $65 billion, in constant 2021 prices. These figures are vastly underestimated because they only consider direct tax losses and not the indirect tax losses that occur when governments make policy changes to curtail tax abuses.4Tax Justice NetworkThe state of tax justice 2021.https://taxjustice.net/wp-content/uploads/2021/11/State_of_Tax_Justice_Report_2021_ENGLISH.pdfDate: November, 2021Date accessed: May 11, 2022Google Scholar For example, Rwanda is one of the UN designated least-developed countries and is estimated to lose $105 million from tax abuse in 2021 estimates.4Tax Justice NetworkThe state of tax justice 2021.https://taxjustice.net/wp-content/uploads/2021/11/State_of_Tax_Justice_Report_2021_ENGLISH.pdfDate: November, 2021Date accessed: May 11, 2022Google Scholar If the Rwandan Government revenue was increased by an equivalent amount and spent in the same way as in previous years, it would allow 136 000 additional people to access basic drinking water and 124 000 to access basic sanitation at home.5O'Hare B Hall S Lopez M Murray S The government revenue and development estimations (GRADE).http://med.st-andrews.ac.uk/gradeDate: 2020Date accessed: May 11, 2022Google Scholar For provision of universal water, sanitation, hygiene, and waste management services to public health-care facilities and to communities, a just global tax system is crucial. For this to happen, the world must start viewing tax abuse through a human rights lens and mandating that multinational corporations report profits and taxes on a country-by-country basis. Global institutions (there is growing support for a UN Tax Convention), states, multinational corporations, investors, and individuals all have a role in bringing this about. Policy coherence mandates that countries that provide aid must review their policies on transparency and tax treaties to ensure they are not impeding the progress of lower-income countries towards their development goals. Many countries who provide aid are currently facilitators of tax abuse, which needs to be urgently addressed on a global level.4Tax Justice NetworkThe state of tax justice 2021.https://taxjustice.net/wp-content/uploads/2021/11/State_of_Tax_Justice_Report_2021_ENGLISH.pdfDate: November, 2021Date accessed: May 11, 2022Google Scholar We declare no competing interests. Funding sources for this Correspondence come from NHS Education Scotland, Global Challenges Research Fund, Scottish Funding Council, Prof Sonia Buist Global Child Health Fund, and Wellcome Trust. Estimating the cost of achieving basic water, sanitation, hygiene, and waste management services in public health-care facilities in the 46 UN designated least-developed countries: a modelling studyInvestment will need to increase to reach full coverage of basic WASH and waste services in public health facilities. Financial needs are modest compared with current overall health and WASH spending, and better service coverage will yield substantial health benefits. To sustain services and prevent degradation and early replacement, countries will need to routinely budget for operations and maintenance of WASH and waste management assets. Full-Text PDF Open Access